The labeling for Privigen was modified in April 2012 to include information on risk factors for hemolysis. The FDA is continuing to evaluate this issue to determine the need for any further regulatory action.

Iodinated contrast agent products

Thyroid dysfunction (hyperthyroidism and hypothyroidism)

The FDA is continuing to evaluate these issues to determine whether the current labeling, which contains information about thyroid dysfunction, is adequate.

Seminar on Health and Happiness organised jointly by Heart Care Foundation of India and Bharatiya Vidya Bhawan at Bharatiya Vidya Bhawan on 05th July 2012. Dr Dinyar Patel was awarded by a memento in the occasion.

Weeks after it received complaints that several college managements were fudging attendance records to help students qualify for examinations, the state medical university has made it mandatory for all medical, dental and paramedical colleges to install biometric attendance devices on their campuses. From this academic year, students and teachers in the medical, dental and paramedical streams will record their attendance only through the biometric mode, TN Dr MGR Medical University vice–chancellor Mayil Vahanan Natarajan said. (Source: TOI, Jul 18, 2012)

The Medical Council of India (MCI) is considering to shrink the MBBS internship by six months and make one–year rural posting compulsory for the MBBS doctors. The move will extend the duration of the MBBS course to six years instead of the existing five–and–a-half–years.

Earlier this year, the union health minister Ghulam Nabi Azad had approved extending the MBBS course by one year and make rural posting compulsory. However, the proposal received flak from the Indian Medical Association (IMA) and doctors. A committee that was formed to look into the proposal of extending the MBBS course to 6.5 years have given an option to reduce the internship by six months and make rural posting compulsory for one year. An increase of six months in the total MBBS course is likely to be accepted by the doctors. (Source: Asian Age)

Two researchers have developed a new metric, called A Body Shape Index (ABSI), for determining how obesity can predict the risk of premature mortality, they report in a study published online today in PLos One. (Source: Medscape)

The FDA has approved the weight–loss drug Qsymia, formerly Qnexa, (Vivus, Mountain View, CA), which now joins lorcaserin (Belviq, Arena Pharmaceuticals, San Diego, CA) as the first anti–obesity medications to enter the US market since 1999. Vivus reported the agency’s decision today. Qsymia, a controlled–release preparation of the drugs phentermine and topiramate in one capsule, is now indicated for weight loss and maintenance of weight loss for people who are obese, or those who are overweight and have weight–related conditions such as hypertension, type 2 diabetes, or dyslipidemia. (Source: Medscape)

The US Food and Drug Administration (FDA) has published its latest quarterly list of drugs to monitor after having identified possible signs of serious risks or new safety information in the agency’s Adverse Event Reporting System (AERS) database during the first 3 months of 2012. The latest FDA watch list consists of 4 drugs that treat seizures, postpartum hemorrhaging, asthma, and immune system disorders, as well as an X–ray contrast agent. (Source: Medscape)

Adding vitamin B12 to the standard antiviral treatments taken by people who were chronically infected with hepatitis C virus (HCV) but who were naive to antiviral therapy improved their ability to clear the virus by 34%, according to results from an open–label pilot study. Alba Rocco, MD, from the Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples "Federico II" in Italy, and colleagues report their findings in a study published online on July 17 in Gut. (Source: Medscape)

Endometrial polyps are lesions commonly found in infertility patients. Polyps are an overgrowth of the tissue that lines the uterine cavity or cervix.

Uterine fibroids are noncancerous growths in your uterus. These growths can cause heavy bleeding if they are in the inside of the uterus. A hysteroscope can be used to remove these growths.

Intrauterine scar tissue can be removed with either office or operative hysteroscopy. To prevent scar tissue from returning, your doctor may give you estrogen and place a balloon in your uterus for up to a week after surgery. A follow–up hysteroscopy or other method of uterine evaluation may also be needed to determine if scar tissue has returned.

Rivers do not drink their own water, nor do tree eat their own fruit, nor do rain clouds eat the grains reared by them. The wealth of the noble is used solely for the benefit of others! Even after accepting that giving is good and that one must learn to give, several questions need to be answered.

1. The first question is: When should one give?

We all know the famous incident from Mahabharat: Yudhishthir asks a beggar seeking alms to come the next day. On this, Bhim rejoices that Yudhishthir his brother, has conquered death! For he is sure that he will be around the next day to give. Yudhishthir gets the message.

One does not know really whether one will be there tomorrow to give!

The time to give therefore is now.

2. The next question is: ‘How much to give?’

One recalls the famous incident from history: Rana Pratap was reeling after defeat from the Mughals. He had lost his army, he had lost his wealth, and most important, he had lost hope, his will to fight. At that time, in his darkest hour, his erstwhile minister, Bhamashah, came seeking him and placed his entire fortune at the disposal of Rana Pratap. With this, Rana Pratap raised an army and lived to fight another day.

Give as much as one can!

3. The next question is: ‘What to give?’

It is not only money that can be given away. It could be a flower or even a smile.

It is not how much one gives but how one gives that really matters. When you give a smile to a stranger that may be the only good thing received by him in days and weeks!

"You can give anything but you must give with all your heart!"

4. One also needs answer to this question whom to give?

Many times we avoid giving by finding fault with the person who is seeking. However, being judgmental and rejecting a person on the presumption that he may not be the most deserving is not justified."Give without being judgmental!"

5. Next we have to answer: ‘How to give?’

Coming to the manner of giving, one has to ensure that the receiver does not feel humiliated, nor the giver feels proud by giving.

In giving, follow the advice ‘Let not your left hand know what your right hand gives? Charity without publicity and fanfare is the highest form of charity.’

‘Give quietly!’

While giving, let not the recipient feel small or humiliated. After all, what we give never really belonged to us. We come to this world with nothing and will go with nothing. The thing gifted was only with us for a temporary period. Why then take pride in giving away something which really did not belong to us?

Give with grace and with a feeling of gratitude.

6. "What should one feel after giving?"

We all know the story of Eklavya. When Dronacharya asked him for his right thumb as "Guru Dakshina, he unhesitatingly cut off the thumb and gave it to Dronacharya.

There is a little known sequel to this story.

Eklavya was asked whether he ever regretted the act of giving away his thumb. He replied, and the reply has to be believed to be true, as it was asked to him when he was dying.

His reply was "Yes! I regretted this only once in my life. It was when Pandavas were coming in to kill Dronacharya who was broken hearted on the false news of death of his son, Ashwathama, and had stopped fighting. It was then that I regretted the loss of my thumb. If the thumb was there, no one could have dared hurt my Guru?

The message to us is clear. Give and never regret giving!

7. And the last question is: ‘How much should we provide for our heirs?’

Ask yourself ‘are we taking away from them the gift of work? – A source of happiness? The answer is given by Warren Buffett:

"Leave your kids enough to do anything, but not enough to do nothing!"

I would conclude by saying: Let us learn the Art of Giving, and quoting Saint Kabir: "When the wealth in the house increases, when water fills a boat, throw them out with both hands!"

Situation: A female patient C/O lower abdominal pain, fever and had uterine tenderness on bimanual palpation. Reaction: You should do cervical swabs and consider starting antibiotics. Lesson: Make Sure to remember that a woman with such symptoms may have endometritis, which requires prompt diagnosis and may respond to doxycycline and metronidazole.

It is in conformity with law (Regulation no. 1.5 of the MCI Regulations, 2002, reproduced below), which states—

1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.

It will reduce/break the unholy nexus between the doctors, the drug sellers and the pharma companies, the result of the nexus being that all the 3 gain financially at the expense of the gullible common man who does not even know that he is being fleeced by the front man of the nexus—the physician.

It will increase the intellectual level of the physicians because they will have to remember and probably read up a little pharmacology/clinical pharmacology to sensibly remember the generic names.

It will be a teaching exercise for the physicians because some of them (or many) would discover that two drugs, which they earlier believed to be different, are really identical.

It will markedly reduce the tendency of the pharma companies to come out with fancy brand names with fancier pricing and packaging. Such outward presentation and pricing aspects will lose all charm for them if they know that the physicians will prescribe by only generic names. Fewer brand names mean less marketing forces and less fleecing of public.

The reasons why doctors are against using generic names are as follows:

They will have to exercise their grey matter a bit (which many of them claim to have plenty of, but are too miserly to use it).

They will lose kick backs from the pharma companies for prescribing their drugs.

They will not be able to fool the patient by prescribing the same drug over and over again under different brand names, with the patient believing that the physician is giving them the benefit of applying his professional mind and devising newer and, often, costlier strategies.

Doctors are in the habit of blaming others (government, politicians, IMA etc.) all the time for the problems related to health and medicine, while they themselves assume an innocent saintly posture. Prescribing by generic names is one area where action lies on THEIR part, not anybody else. It hurts when one has to work. Everybody wants to avoid work. Doctors are no exception.

Doctors often shout from the rooftops about the problem of quackery. This (generic prescriptions) is one step that will result in reducing and identifying quacks. How many quacks will be able to write names like ibuprofen, xylometazoline, nifedipine etc.?

Doctors hold out commonly this argument against generic prescriptions—that the drug supplied by the seller to the buyer patient may not be effective. Supposing this occasionally happens, then how can the doctor be held liable if there is a mishap? The culpability will shift away from the doctor to the manufacturer and the supplier/seller.

Fitness Update

(Rajat Bhatnagar, MonaVie www.mymonavie.com/sonraj)

Can alcohol help with bone density in post 50 women?

Later in life, drinking one to two alcoholic drinks daily may curb bone loss — so much so that just a two–week break from alcohol hastened bone decline in women in a new study. Researchers looked at the effects of moderate alcohol consumption on "bone turnover," or the replacing of old bone cells with new ones, in healthy post–menopausal women. After menopause, women's production of new bone cells slows, but the rate of shedding old cells does not slow as much. In other words, the "out with the old" outpaces the "in with the new," leading to a porous skeleton that easily fractures.

But past studies have shown that women who drink moderately (one or two alcoholic beverages per day) have higher bone density than non–drinkers or heavy drinkers. Now, the new study suggests why: Alcohol appears to reduce bone loss in middle–age women by suppressing the rate at which their bones shed old cells.

In line with previously observed trends, the women in the study who drank more alcohol (up to two drinks per day) had denser hip bones than those who drank less (as little as half a drink per day). More tellingly, blood tests showed that abstaining from drinking for just two weeks triggered an acceleration of bone turnover in all the women. After a 14–day alcohol holiday, the women’s blood contained heightened levels of a molecule that gets released during bone turnover. And less than a day after the women resumed their normal drinking, blood levels of that molecule dropped again. "After less than 24 hours, to see such a measurable effect was really unexpected," said study researcher Urszula Iwaniec, associate professor in the College of Public Health and Human Sciences at Oregon State University.

Quote of the Day

(Dr GM Singh)

A healthy attitude is contagious but don’t wait to catch it from others. Be a carrier. Tom Stoppard

Lab Update

(Dr Navin Dang and Dr Arpan Gandhi)

Serum lactate dehydrogenase

Lactate dehydrogenase (LDH or LD) is an enzyme found in almost all body tissues, but only in a small amount in the blood. LDH is found in the bloodstream when cells are damaged. Because of this, LDH test can be used as a general marker of cells damage. Level of LDH may be measured either as a total LDH or as LDH isoenzymes.

Elevated levels of LDH may be seen with:

Cerebrovascular accident (CVA, stroke)

Drugs: anesthetics, aspirin, narcotics, procainamides, alcohol

Hemolytic anemias

Pernicious anemia (megaloblastic anemia)

Infectious mononucleosis (Mono)

Intestinal and pulmonary infarction

Kidney disease

Liver disease

Muscular dystrophy

Pancreatitis

Lymphoma or other cancers

Mind Teaser

Read this…………………

A client is scheduled for a bronchoscopy. When teaching the client what to expect afterward, the nurse's highest priority of information would be

A. Food and fluids will be withheld for at least 2 hours.
B. Warm saline gargles will be done q 2h.
C. Coughing and deep-breathing exercises will be done q2h.
D. Only ice chips and cold liquids will be allowed initially.

Yesterday’s Mind Teaser: A client with COPD is being prepared for discharge. The following are relevant instructions to the client regarding the use of an oral inhaler except:

A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth.
B. Inhale slowly through the mouth as the canister is pressed down
C. Hold his breath for about 10 seconds before exhaling
D. Slowly breath out through the mouth with pursed lips after inhaling the drug

Answer for yesterday’s Mind Teaser: D. Slowly breath out through the mouth with pursed lips after inhaling the drug

Indian studies have reported case fatality rates of Hib meningitis of 20–29%, while all invasive Hib disease (including meningitis) had a case fatality rate of 16%. We must use the vaccine and immunize the infants as per schedule, even if at some cost to parents. Let us see the ways in which the conjugate Hib vaccine protects individuals and benefits communities.

Efficacy: The efficacy of conjugate Hib vaccines amongst fully vaccinated children is reported to be >95%. Hib vaccine is not effective against non–type B Haemophilus influenzae. However, non–type B disease is rare in comparison to pre–vaccine Haemophilus influenzae type B disease.

Safety: Clinical trials and ongoing surveillance have shown Hib vaccine to be safe. In general, adverse reactions to the vaccine are mild. The most common reactions are mild fever, loss of appetite, transient redness, swelling, or pain at the site of injection, occurring in 5–30% of vaccine recipients. More severe reactions are extremely rare.

Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to their vaccine components, age of child to be vaccinated – less than 6 weeks

Impact: Prior to introduction of the conjugate vaccine, Hib was a leading cause of childhood meningitis, pneumonia, and inflammation of the epiglottis, mostly in children under 5 years of age. Since routine vaccination began, the incidence of Hib disease has declined by greater than 99%, effectively eliminating Hib as a public health problem in USA. Similar reductions in disease occurred after introduction of the vaccine in Western Europe and developing countries.

Herd immunity: The immunization of children with Hib vaccine created an effect/impact, that of reduction of Hib infection in adults. This decrease occurred because of herd immunity developed as a result of immunization; immunized children were not infected and so did not become nasal carriers of this bacteria, and thus eliminated the source of bacteria for adults consequently reducing the rate of Hib infection in adults.

UK Clinical negligence law defines negligence as any act or omission which falls short of a standard to be expected of "the reasonable man."

It is necessary to show that whatever the Doctor did or did not do fell below the standard of a reasonably competent Doctor in that field of medicine.

In the leading case of "Bolam – v – Friern Hospital Management Committee 1957," it was stated that a doctor must act in accordance with a practice which is accepted as proper by a responsible body of men

There are several acceptable ways of doing something and this may mean that there is no negligence if an alternative method is chosen.

The fact that another person would not have done things in the same way does not automatically mean that there was clinical negligence.

The Doctor will be able to defend the compensation claim successfully, if it can show that a responsible body of reputable Doctors in the relevant field would have acted in a similar manner.

This means that a judge will hear evidence from experts and decide whether the actions taken were appropriate.

Pregnancy is not contraindicated in most women with diabetic nephropathy (kidney disease) said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Maternal and peri– birth outcomes are generally good with tight control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are increased compared to non–diabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction and preterm birth.

Pre–conceptional treatment with drugs like angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic.

Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

A non stop question answer session between all the top cardiologists of the NCR region and the mass public. Event will be promoted through hoardings, our publications and the press. Public health discussions